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Prescribing Pattern of Antibiotics In Neonates in a Tertiary Care Hospital
A416
VA L U E I N H E A LT H 1 7 ( 2 0 1 4 ) A 3 2 3 – A 6 8 6
NSAIDs present in household drug supplies, and address the issue of possible inadequate use. Methods: This was an observational, cross-sectional study of drug storage and self-medication practice in households in the city of Novi Sad, Serbia over the 8 months period. Study consisted of personal insight into the drug inventory, and drugs were classified according the Anatomical Therapeutic Chemical (ATC) classification system. Results: Out of 383 surveyed households, 280/383 (73%) households held at least one box of NSAID in their home-pharmacy and a total of 473 packages of NSAID have been inventored. Most commonly encountered NSAIDs were ibuprofen (52.64%), diclofenac (31.92%), nimesulide (8.03%) and meloxicam (3.38%). Other NSAIDs accounted for less than 4% altogether. Over 70% of all NSAIDs present have been bought without prescription. Majority of ibuprfoen (91.3%) and diclofenac (65.74%) were obtained without a prescription even though in Serbia all NSAIDs (except ibuprofen 200mg) are prescription only medication (POM). According to European Medicine Agency, ibuprofen is classified as OTC, but diclofenac is strictly POM. Large amount of diclofenac used without consulting a physician presents a serious issue. Nimesulide and meloxicam were almost exclusively bought with prescription (> 80%). Conclusions: NSAIDs were present in most of Serbian home-pharmacies and were usually bought without prescription. This present a serious problem, especially for unsupervized diclofenac use. Financial Sources: This work was supported by the Ministry of Science and Technological Development, Republic of Serbia, project No. 41012. PHP70 Pharmacoeconomic Analysis of Antifungal Drug Use in the Intensive Care Unit Selimzyanova L , Namazova-Baranova L , Vishneva E , Lazareva A , Katosova L , Kryzanovskaya O , Tepaev R Federal State Budgetary Institution “Scientific Centre of Children Health” under the Russian Academy of Medical Sciences, Moscov, Russia .
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Objectives: to investigate changing of Candida species (C. spp) distribution and expenditure for antimicrobial drugs in the intensive care unit (ICU). Methods: from 1.01.11 to 30.07.13 there were 200 patients with Candida spp positive samples in the ICU. We followed up antifungal drugs susceptibility of different C. spp. and evaluated expenditure for antifungal drugs. Results: C spp was detected in 200 patients (12,2% of ICU microbiota). In 2011: 47 (19,3%); in 2012: 50 (9,3%); in 2013: 103 (12,1%) patients. The predominant species, detected during period of investigation was Candida albicans (C.a.), which was isolated in 21 (44,7%), 21 (42%) and 52 (50,5%) patients in 2011,2012 and 2013 accordingly. Candida parapsilosis (C.p.) was on second place and frequency of this fungus detecting increased: 1 (2,1%); 12 (24%); 31 (30,1%) patients. Candida tropicalis (C.t.) was detected: in 5 (10,6%); 6 (12%); 10 (9,7%) patients. Candida glabrata (C.g.): in 9 (19,1%); 3 (6%); 2 (1,9%). Candida krusei (C.k.): in 6 (12,8%); 1 (2%); 1 (1%). Candida lusitaniae (C.l.): in 2 (4,3%); 2 (4%); 3 (2,9%). Fluconazole susceptibility was: for C.a.: 100%; 89%; 97%; C.t. 82%; 94%, 92%, C.g 18%; 46%; 0% in 2011, 2012 and 2013 accordingly; for C.p.: in 2012; 29%: in 2013: 23%. Changing of C. spp species distribution led to increasing of expenditure for antifungal drugs in ICU: 52% of expenditure for antimicrobial drugs in 2011; 72% in 2012; 78% in 2013. Echinocandines determined 44%; 65% and 70% of ICU expenditure for antimicrobial drugs in 2011; 2012; 2013 accordingly. Conclusions: Our data coordinate with modern tendency in C. spp changing in ICUs. Increasing of C. spp proportion, resistant to fluconazole requires more frequent echinocandines use, that leads to rise of hospital expenditure. PHP71 Impact of the Early Benefit Assessment on A Pharmaceutical’s Real Consumption in Germany Kotowa W 1, Häussler B 2, Reindl S 1, Höer A 2 1IGES Institut GmbH, Nuremberg, Germany, 2IGES Institut GmbH, Berlin, Germany .
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Objectives: The Act on the Reform of the Market for Medicinal Products (“AMNOG”) introduced an early benefit assessment (EBA) of pharmaceuticals in Germany in 2011. Since the impact of the results of the EBA on a pharmaceutical’s consumption is unclear, those effects were quantitatively analyzed. Methods: All pharmaceuticals which were assessed by an EBA in 2011 or 2012 and were still available in 2012 and 2013, and gliptins launched before 2011 with an EBA in 2013 were considered. A pharmaceutical’s real consumption (measured by defined daily doses) in 2012 and 2013 was compared to the expected consumption (EC) based on the highest possible number of patients defined by the Federal Joint Committee according to a pharmaceutical’s label. For the EC only subpopulations with an acknowledged additional benefit (AB) were taken into account. Results are presented in terms of „shares“ (= real consumption / EC). Results: Pharmaceuticals with a low share (< 10%) were cabazitaxel (0.22% in 2012), saxagliptin, protease inhibitors against chronic hepatitis C, eribulin, vandetanib and rilpivirin. Sitagliptin, ticagrelor, antineoplastic agents and tafamidis achieved a midsize share (10-50%). Ivacaftor, abiraterone, emtricitabin/rilpivirin/tenofovir, apixaban, fingolimod and axitinib reached shares of > 50% and up to 398%, respectively (fingolimod in 2013). There was no correlation between the extent of AB and a pharmaceutical‘s share. For most pharmaceuticals consumption was higher in 2013 than 2012. Conclusions: The shares of pharmaceuticals considered in this analysis vary between 0.22% and 398%. No correlation between share and extent of AB could be identified. It is assumed that label restrictions regarding the use of a pharmaceutical, competing alternatives in the same therapeutic indication, a pharmaceutical’s life-cycle or overestimation of the EC influence a pharmaceutical’s share. Shares > 100% indicate that also subpopulations without an acknowledged AB receive treatment with the respective pharmaceutical. Further research is needed to confirm these assumptions. PHP72 Using Data Envelopment Analysis (Dea) To Rank Gp’s According To Their P4p Quality and Efficiency Scores Perronnin M , Pichetti S , Sermet C IRDES, Paris, France .
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Objectives: Payments for Performance (P4P) schemes are commonly used in many OECD countries in order to incite physicians to improve both quality and efficiency of prescribing. In France, a set of 29 indicators has been selected as the P4P perimeter by National Public Health Insurance. Each indicator provides useful information of GPs’ performance, but it is not that easy to combine them all at the same time in order to provide a synthetic view of GPs’ performance. Instead, some of these indicators can be grouped together according to a therapeutic rationale (diabetes indicators, high blood pressure indicators) or an efficiency rationale (multiple-sourced drug prescribing). Data Envelopment Analysis (DEA) can be used to calculate an aggregated score for each GP and for each dimension (therapeutic or efficiency). Methods: Database used in this study were taken from the IMS-Health Disease Analyzer (DA) database. It contains information on pharmaceutical prescriptions administered by 693 French General Practitioners and related diagnoses. Quality and efficiency indicators are calculated both inside and outside P4P perimeter. Indicators reflecting efficiency are considered separately from those reflecting quality and the latter are grouped according to therapeutic rationale (diabetes, high blood pressure). Data Envelopment Analysis (DEA) is used to produce performance scores while aggregating several efficiency or quality scores and neutralizing at the same time each GP’s characteristics. Results: DEA scores are calculated on each dimension (quality or efficiency) and for each GP. Comparing the scores on each dimension enables to better understand if GPs’ are faced with a trade-off between these two Objectives. Conclusions: Results from this analysis may have implications for public policy design. A better understanding of GPs’ strategies relatively to P4P schemes could enable to adapt incentives in order to improve the system. PHP73 Prescribing Pattern of Antibiotics In Neonates in a Tertiary Care Hospital Thakur S 1, Acharya L D 1, Lewis L E S 2, Kumar R 1, Kumar S 1 1Manipal College of Pharmaceutical Sciences Manipal University, Manipal, Karnataka,, India, 2Kasturba Medical College Manipal Univeristy, Manipal, Karnataka, India .
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Objectives: Neonates are among special population group who are more susceptible to nosocomial infections due to underdeveloped immunity level at their age (0-28 days of life) and it is a common practice of administering antibiotics, pending bacterial culture results, to sick neonates and to neonates who are more prone to develop infectious diseases; which in turn is gradually progressing towards a global problem of multidrug antibiotic resistance in Neonatal Intensive Care Units. Objective of the present study was to study prescribing patterns of antibiotics in hospitalized neonates, and to assess duration of therapy, antibiotic regimen and outcome of therapy. Methods: All neonates prescribed with antibiotics during 6 months period from November 2014 to April 2014 were selected. A prospective observational study was carried on selected cases by using sources of data such as patient treatment charts, progress sheet, laboratory investigation reports, and patient discharge summary; collected datas were reported in case record forms. Data analysis was done with SPSS (18.0), Microsoft Excel (2010). Results: Of the total of 404 admitted neonates, 30% (n = 122) were prescribed with antibiotics; among which 76 (62.3%) males and 46 (37.7%) were females. Among n= 122 cases, 71 (58.2%) empirically and 51 (41.8%) were prescribed in indication of infections. Most commonly prescribed antibiotic class were Aminoglycoside (97.54%), broad spectrum penicillin (66.39%), extended spectrum penicillin (28.68%), 2ndgeneration cephalosporin (17.21%). Empirical use of ampicillin and amikacin were most frequently encountered. Our study showed that Dual antibiotic regimen produced a better outcome (50%) than single/triple/more antibiotic regimen. Conclusions: The broader outcome of this study would be the potential utility of this data in designing strategies both at level of physicians and administrators for rational prescribing and policy decisions respectively; so that a continuous surveillance for rational use of antibiotics and strategy of antibiotic cycling can provide some better answers for difficulties coming across in management of neonatal infections. PHP74 Do Quality or Efficiency Indicators Inside French P4p Perimeter Influence Quality Or Efficiency Indicators Outside P4p? Pichetti S, Perronnin M, Sermet C IRDES, Paris, France
Objectives: Payments for Performance (P4P) schemes are commonly used in many OECD countries in order to incite physicians to improve both quality and efficiency of prescribing. In France, a set of 29 indicators has been selected as the P4P perimeter by National Public Health Insurance. P4P schemes may induce undesirable behaviors from GPs leading to a decrease both in quality and efficiency outside the P4P perimeter (De Pouvourville, 2013). On the contrary, other studies (Campbell et al., 2009) tend to show that respecting P4P targets may imply a virtuous effect outside P4P. Methods: Database used in this study were taken from the IMS-Health Disease Analyzer (DA) database. It contains information on pharmaceutical prescriptions administered by 693 French General Practitioners and related diagnoses. Quality and efficiency indicators are calculated both inside and outside P4P perimeter. In a first step, each category –quality or efficiency- is considered separately. We calculate an aggregated score for each category, by averaging indicators pertaining to it. In a second step, each indicator outside the P4P perimeter is regressed on quality or efficiency aggregated scores, controlling for other characteristics of the physician. Results: At first sight, there is no obvious link between quality and efficiency scores inside and outside P4P perimeter. As a matter of fact, descriptive statistics, correlation analysis and Principal Component Analysis do not show any straightforward relation. All these first results call for further analyses. Conclusions: Results from this analysis may have implications for public policy design. If respecting P4P targets imply a virtuous effect outside P4P, there is no need to extend the P4P perimeter. If not, regulatory agency has to increase the number of indicators in order to improve quality and efficiency.
VA L U E I N H E A LT H 1 7 ( 2 0 1 4 ) A 3 2 3 – A 6 8 6
NSAIDs present in household drug supplies, and address the issue of possible inadequate use. Methods: This was an observational, cross-sectional study of drug storage and self-medication practice in households in the city of Novi Sad, Serbia over the 8 months period. Study consisted of personal insight into the drug inventory, and drugs were classified according the Anatomical Therapeutic Chemical (ATC) classification system. Results: Out of 383 surveyed households, 280/383 (73%) households held at least one box of NSAID in their home-pharmacy and a total of 473 packages of NSAID have been inventored. Most commonly encountered NSAIDs were ibuprofen (52.64%), diclofenac (31.92%), nimesulide (8.03%) and meloxicam (3.38%). Other NSAIDs accounted for less than 4% altogether. Over 70% of all NSAIDs present have been bought without prescription. Majority of ibuprfoen (91.3%) and diclofenac (65.74%) were obtained without a prescription even though in Serbia all NSAIDs (except ibuprofen 200mg) are prescription only medication (POM). According to European Medicine Agency, ibuprofen is classified as OTC, but diclofenac is strictly POM. Large amount of diclofenac used without consulting a physician presents a serious issue. Nimesulide and meloxicam were almost exclusively bought with prescription (> 80%). Conclusions: NSAIDs were present in most of Serbian home-pharmacies and were usually bought without prescription. This present a serious problem, especially for unsupervized diclofenac use. Financial Sources: This work was supported by the Ministry of Science and Technological Development, Republic of Serbia, project No. 41012. PHP70 Pharmacoeconomic Analysis of Antifungal Drug Use in the Intensive Care Unit Selimzyanova L , Namazova-Baranova L , Vishneva E , Lazareva A , Katosova L , Kryzanovskaya O , Tepaev R Federal State Budgetary Institution “Scientific Centre of Children Health” under the Russian Academy of Medical Sciences, Moscov, Russia .
.
.
.
.
.
.
Objectives: to investigate changing of Candida species (C. spp) distribution and expenditure for antimicrobial drugs in the intensive care unit (ICU). Methods: from 1.01.11 to 30.07.13 there were 200 patients with Candida spp positive samples in the ICU. We followed up antifungal drugs susceptibility of different C. spp. and evaluated expenditure for antifungal drugs. Results: C spp was detected in 200 patients (12,2% of ICU microbiota). In 2011: 47 (19,3%); in 2012: 50 (9,3%); in 2013: 103 (12,1%) patients. The predominant species, detected during period of investigation was Candida albicans (C.a.), which was isolated in 21 (44,7%), 21 (42%) and 52 (50,5%) patients in 2011,2012 and 2013 accordingly. Candida parapsilosis (C.p.) was on second place and frequency of this fungus detecting increased: 1 (2,1%); 12 (24%); 31 (30,1%) patients. Candida tropicalis (C.t.) was detected: in 5 (10,6%); 6 (12%); 10 (9,7%) patients. Candida glabrata (C.g.): in 9 (19,1%); 3 (6%); 2 (1,9%). Candida krusei (C.k.): in 6 (12,8%); 1 (2%); 1 (1%). Candida lusitaniae (C.l.): in 2 (4,3%); 2 (4%); 3 (2,9%). Fluconazole susceptibility was: for C.a.: 100%; 89%; 97%; C.t. 82%; 94%, 92%, C.g 18%; 46%; 0% in 2011, 2012 and 2013 accordingly; for C.p.: in 2012; 29%: in 2013: 23%. Changing of C. spp species distribution led to increasing of expenditure for antifungal drugs in ICU: 52% of expenditure for antimicrobial drugs in 2011; 72% in 2012; 78% in 2013. Echinocandines determined 44%; 65% and 70% of ICU expenditure for antimicrobial drugs in 2011; 2012; 2013 accordingly. Conclusions: Our data coordinate with modern tendency in C. spp changing in ICUs. Increasing of C. spp proportion, resistant to fluconazole requires more frequent echinocandines use, that leads to rise of hospital expenditure. PHP71 Impact of the Early Benefit Assessment on A Pharmaceutical’s Real Consumption in Germany Kotowa W 1, Häussler B 2, Reindl S 1, Höer A 2 1IGES Institut GmbH, Nuremberg, Germany, 2IGES Institut GmbH, Berlin, Germany .
.
.
.
Objectives: The Act on the Reform of the Market for Medicinal Products (“AMNOG”) introduced an early benefit assessment (EBA) of pharmaceuticals in Germany in 2011. Since the impact of the results of the EBA on a pharmaceutical’s consumption is unclear, those effects were quantitatively analyzed. Methods: All pharmaceuticals which were assessed by an EBA in 2011 or 2012 and were still available in 2012 and 2013, and gliptins launched before 2011 with an EBA in 2013 were considered. A pharmaceutical’s real consumption (measured by defined daily doses) in 2012 and 2013 was compared to the expected consumption (EC) based on the highest possible number of patients defined by the Federal Joint Committee according to a pharmaceutical’s label. For the EC only subpopulations with an acknowledged additional benefit (AB) were taken into account. Results are presented in terms of „shares“ (= real consumption / EC). Results: Pharmaceuticals with a low share (< 10%) were cabazitaxel (0.22% in 2012), saxagliptin, protease inhibitors against chronic hepatitis C, eribulin, vandetanib and rilpivirin. Sitagliptin, ticagrelor, antineoplastic agents and tafamidis achieved a midsize share (10-50%). Ivacaftor, abiraterone, emtricitabin/rilpivirin/tenofovir, apixaban, fingolimod and axitinib reached shares of > 50% and up to 398%, respectively (fingolimod in 2013). There was no correlation between the extent of AB and a pharmaceutical‘s share. For most pharmaceuticals consumption was higher in 2013 than 2012. Conclusions: The shares of pharmaceuticals considered in this analysis vary between 0.22% and 398%. No correlation between share and extent of AB could be identified. It is assumed that label restrictions regarding the use of a pharmaceutical, competing alternatives in the same therapeutic indication, a pharmaceutical’s life-cycle or overestimation of the EC influence a pharmaceutical’s share. Shares > 100% indicate that also subpopulations without an acknowledged AB receive treatment with the respective pharmaceutical. Further research is needed to confirm these assumptions. PHP72 Using Data Envelopment Analysis (Dea) To Rank Gp’s According To Their P4p Quality and Efficiency Scores Perronnin M , Pichetti S , Sermet C IRDES, Paris, France .
.
.
Objectives: Payments for Performance (P4P) schemes are commonly used in many OECD countries in order to incite physicians to improve both quality and efficiency of prescribing. In France, a set of 29 indicators has been selected as the P4P perimeter by National Public Health Insurance. Each indicator provides useful information of GPs’ performance, but it is not that easy to combine them all at the same time in order to provide a synthetic view of GPs’ performance. Instead, some of these indicators can be grouped together according to a therapeutic rationale (diabetes indicators, high blood pressure indicators) or an efficiency rationale (multiple-sourced drug prescribing). Data Envelopment Analysis (DEA) can be used to calculate an aggregated score for each GP and for each dimension (therapeutic or efficiency). Methods: Database used in this study were taken from the IMS-Health Disease Analyzer (DA) database. It contains information on pharmaceutical prescriptions administered by 693 French General Practitioners and related diagnoses. Quality and efficiency indicators are calculated both inside and outside P4P perimeter. Indicators reflecting efficiency are considered separately from those reflecting quality and the latter are grouped according to therapeutic rationale (diabetes, high blood pressure). Data Envelopment Analysis (DEA) is used to produce performance scores while aggregating several efficiency or quality scores and neutralizing at the same time each GP’s characteristics. Results: DEA scores are calculated on each dimension (quality or efficiency) and for each GP. Comparing the scores on each dimension enables to better understand if GPs’ are faced with a trade-off between these two Objectives. Conclusions: Results from this analysis may have implications for public policy design. A better understanding of GPs’ strategies relatively to P4P schemes could enable to adapt incentives in order to improve the system. PHP73 Prescribing Pattern of Antibiotics In Neonates in a Tertiary Care Hospital Thakur S 1, Acharya L D 1, Lewis L E S 2, Kumar R 1, Kumar S 1 1Manipal College of Pharmaceutical Sciences Manipal University, Manipal, Karnataka,, India, 2Kasturba Medical College Manipal Univeristy, Manipal, Karnataka, India .
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.
.
.
.
.
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Objectives: Neonates are among special population group who are more susceptible to nosocomial infections due to underdeveloped immunity level at their age (0-28 days of life) and it is a common practice of administering antibiotics, pending bacterial culture results, to sick neonates and to neonates who are more prone to develop infectious diseases; which in turn is gradually progressing towards a global problem of multidrug antibiotic resistance in Neonatal Intensive Care Units. Objective of the present study was to study prescribing patterns of antibiotics in hospitalized neonates, and to assess duration of therapy, antibiotic regimen and outcome of therapy. Methods: All neonates prescribed with antibiotics during 6 months period from November 2014 to April 2014 were selected. A prospective observational study was carried on selected cases by using sources of data such as patient treatment charts, progress sheet, laboratory investigation reports, and patient discharge summary; collected datas were reported in case record forms. Data analysis was done with SPSS (18.0), Microsoft Excel (2010). Results: Of the total of 404 admitted neonates, 30% (n = 122) were prescribed with antibiotics; among which 76 (62.3%) males and 46 (37.7%) were females. Among n= 122 cases, 71 (58.2%) empirically and 51 (41.8%) were prescribed in indication of infections. Most commonly prescribed antibiotic class were Aminoglycoside (97.54%), broad spectrum penicillin (66.39%), extended spectrum penicillin (28.68%), 2ndgeneration cephalosporin (17.21%). Empirical use of ampicillin and amikacin were most frequently encountered. Our study showed that Dual antibiotic regimen produced a better outcome (50%) than single/triple/more antibiotic regimen. Conclusions: The broader outcome of this study would be the potential utility of this data in designing strategies both at level of physicians and administrators for rational prescribing and policy decisions respectively; so that a continuous surveillance for rational use of antibiotics and strategy of antibiotic cycling can provide some better answers for difficulties coming across in management of neonatal infections. PHP74 Do Quality or Efficiency Indicators Inside French P4p Perimeter Influence Quality Or Efficiency Indicators Outside P4p? Pichetti S, Perronnin M, Sermet C IRDES, Paris, France
Objectives: Payments for Performance (P4P) schemes are commonly used in many OECD countries in order to incite physicians to improve both quality and efficiency of prescribing. In France, a set of 29 indicators has been selected as the P4P perimeter by National Public Health Insurance. P4P schemes may induce undesirable behaviors from GPs leading to a decrease both in quality and efficiency outside the P4P perimeter (De Pouvourville, 2013). On the contrary, other studies (Campbell et al., 2009) tend to show that respecting P4P targets may imply a virtuous effect outside P4P. Methods: Database used in this study were taken from the IMS-Health Disease Analyzer (DA) database. It contains information on pharmaceutical prescriptions administered by 693 French General Practitioners and related diagnoses. Quality and efficiency indicators are calculated both inside and outside P4P perimeter. In a first step, each category –quality or efficiency- is considered separately. We calculate an aggregated score for each category, by averaging indicators pertaining to it. In a second step, each indicator outside the P4P perimeter is regressed on quality or efficiency aggregated scores, controlling for other characteristics of the physician. Results: At first sight, there is no obvious link between quality and efficiency scores inside and outside P4P perimeter. As a matter of fact, descriptive statistics, correlation analysis and Principal Component Analysis do not show any straightforward relation. All these first results call for further analyses. Conclusions: Results from this analysis may have implications for public policy design. If respecting P4P targets imply a virtuous effect outside P4P, there is no need to extend the P4P perimeter. If not, regulatory agency has to increase the number of indicators in order to improve quality and efficiency.